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Journal of Clinical Microbiology, October 2007, p. 3360-3365, Vol. 45, No. 10
0095-1137/07/$08.00+0     doi:10.1128/JCM.01458-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Comparison of the BD GeneOhm VanR Assay to Culture for Identification of Vancomycin-Resistant Enterococci in Rectal and Stool Specimens{triangledown}

Paul D. Stamper,1,2 Mian Cai,1 Clara Lema,3 Kim Eskey,3 and Karen C. Carroll1,3*

Department of Pathology, The Johns Hopkins University School of Medicine,1 Department of International Health Program in Disease Prevention and Control, The Johns Hopkins Bloomberg School of Public Health,2 Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, Maryland3

Received 19 July 2007/ Returned for modification 2 August 2007/ Accepted 10 August 2007

Active screening for vancomycin-resistant enterococci (VRE) in rectal and stool specimens has been recommended to limit the spread of antimicrobial resistance within certain high-risk populations. Directly from 502 rectal swabs and stool specimens, we evaluated the diagnostic performance of the BD GeneOhm VanR assay (BD GeneOhm, San Diego, CA), a rapid real-time PCR test that detects the presence of vanA and/or vanB genes. The VanR assay was compared to culture consisting of both bile-esculin-azide agar with 6 µg/ml vancomycin (BEAV agar) (BD Diagnostics, Sparks, MD) and BEAV broth with 8 µg/ml vancomycin (Hardy Diagnostics, Santa Maria, CA). Enterococci were identified to the species level using standard biochemical tests and a Phoenix automated microbiology system (BD Diagnostics, Sparks, MD). The susceptibility of the enterococci to vancomycin and teicoplanin was determined using an Etest (AB Biodisk, Solna, Sweden). VRE were initially isolated from 147 cultures, and the VanR assay detected 142 of the 147 positive cultures for a sensitivity of 96.6%. The specificity was 87.0% (309/355) largely due to false positives seen with the vanB portion of the assay. The sensitivity when testing rectal swabs was 98.3%, and the sensitivity for stool samples was 95.4% (P = 0.643). The specificity of rectal swabs was comparable to that of the stool specimens (87.5% and 86.5%, respectively). When used only to detect VanA resistance, the VanR assay was 94.4% (136/144) sensitive and 96.4% (345/358) specific, with positive and negative predictive values of 91.3% and 97.7%, respectively. In summary, the BD GeneOhm VanR assay is a good screening test for VRE in our population of predominantly vanA-colonized patients. However, patient samples testing only vanB positive should be confirmed by another method for the presence of VRE.

* Corresponding author. Mailing address: The Johns Hopkins Medical Institutions, Division of Medical Microbiology, Meyer B1-193, 600 N. Wolfe St., Baltimore, MD 21287. Phone: (410) 955-5077. Fax: (410) 614-8087. E-mail: Kcarrol7{at}jhmi.edu

{triangledown} Published ahead of print on 17 August 2007.

Journal of Clinical Microbiology, October 2007, p. 3360-3365, Vol. 45, No. 10
0095-1137/07/$08.00+0     doi:10.1128/JCM.01458-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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